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Meta-Analysis
. 2018;63(2):783-796.
doi: 10.3233/JAD-171093.

A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease

Enrico R Fantoni  1 , Anastasia Chalkidou  2   3 , John T O' Brien  4 , Gill Farrar  1 , Alexander Hammers  3
Affiliations
Meta-Analysis

A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease

Enrico R Fantoni et al. J Alzheimers Dis. 2018.

Abstract

Background: Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification.

Objective: To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects.

Methods: Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing.

Results: For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population.

Conclusions: Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.

Keywords: Alzheimer’s disease; amyloid PET; dementia; diagnostic confidence; differential diagnosis; impact; patient management; quantitative; systematic review; utility.

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Figures

Fig.1
Fig.1
Primary analysis of the diagnostic trajectories for patients without CSF or FDG-PET data available at the time of the pre-scan diagnosis (Group 1). All included subjects were broadly classified into presumed AD, Non-AD or indeterminate as per Supplementary Table 6. Due to the included studies’ reporting format, it was not possible to include cases that undergo the following trajectories: indeterminate-nonAD, nonAD-indeterminate, indeterminate-indeterminate. Hence the only trajectory from indeterminate is indeterminate-AD. Each percentage reported relates to the level above it. Dx, diagnosis. PET, amyloid PET. Color coding from Post-scan Dx onwards: Grey boxes: diagnoses in line with aPET; Black boxes: diagnoses changed in line with PET, Light grey boxes: diagnoses changed or confirmed contradicting PET.
See this image and copyright information in PMC

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